1921
Volume 99, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

The complex relationship between malnutrition and malaria affects morbidity and mortality in children younger than 5 years, particularly in parts of sub-Saharan Africa where these conditions occur together seasonally. Previous research on this relationship has been inconclusive. Here, we examine the association between anthropometric indicators and malaria infection in a population-based sample of children younger than 5 years in Niger. This cross-sectional study is a secondary analysis of a cluster-randomized trial comparing treatment strategies for trachoma in Niger. We included children aged 6–60 months residing in the 48 communities enrolled in the trial who completed anthropometric and malaria infection assessments at the final study visit. We evaluated the association between anthropometric indicators, including height-for-age -score (HAZ) and weight-for-age -score (WAZ) and indicators of malaria infection, including malaria parasitemia and clinical malaria. In May 2013, we collected data from 1,649 children. Of these, 780 (47.3%) were positive for malaria parasitemia and 401 (24.3%) had clinical malaria. In models of malaria parasitemia, the adjusted odds ratio (aOR) was 1.05 (95% confidence interval [CI]: 1.00–1.10) for HAZ and 1.07 (95% CI: 0.99, 1.15) for WAZ. In models of clinical malaria, the aOR was 1.07 (95% CI: 1.02–1.11) for HAZ and 1.09 (95% CI: 1.01–1.19) for WAZ. Overall, we did not find evidence of an association between most anthropometric indicators and malaria infection. Greater height may be associated with an increased risk of clinical malaria.

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References

  1. Global Child Mortality Collaborators GBD, 2016. Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980–2015: a systematic analysis for the Global Burden of Disease study 2015. Lancet 388: 17251774. [Google Scholar]
  2. Black RE, Maternal and Child Nutrition Study Group , 2013. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 382: 427451. [Google Scholar]
  3. Murray CJ, 2014. Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990–2013: a systematic analysis for the Global Burden of Disease study 2013. Lancet 384: 10051070. [Google Scholar]
  4. Burki TK, , 2013. Malaria and malnutrition: Niger’s twin crises. Lancet 382: 587588. [Google Scholar]
  5. Médecins Sans Frontières, 2013. Niger 2013: Tackling the Deadly Combination of Malaria and Malnutrition. Johannesburg, South Africa: MSF.
  6. Ferreira E, Alexandre MA, Salinas JL, de Siqueira AM, Benzecry SG, de Lacerda MV, Monteiro WM, , 2015. Association between anthropometry-based nutritional status and malaria: a systematic review of observational studies. Malar J 14: 346. [Google Scholar]
  7. Scrimshaw NS, SanGiovanni JP, , 1997. Synergism of nutrition, infection, and immunity: an overview. Am J Clin Nutr 66: 464S477S. [Google Scholar]
  8. Page AL, 2013. Infections in children admitted with complicated severe acute malnutrition in Niger. PLoS One 8: e68699. [Google Scholar]
  9. Deen JL, Walraven GE, von Seidlein L, , 2002. Increased risk for malaria in chronically malnourished children under 5 years of age in rural Gambia. J Trop Pediatr 48: 7883. [Google Scholar]
  10. Tonglet R, Mahangaiko Lembo E, Zihindula PM, Wodon A, Dramaix M, Hennart P, , 1999. How useful are anthropometric, clinical and dietary measurements of nutritional status as predictors of morbidity of young children in central Africa? Trop Med Int Health 4: 120130. [Google Scholar]
  11. Williams TN, Maitland K, Phelps L, Bennett S, Peto TE, Viji J, Timothy R, Clegg JB, Weatherall DJ, Bowden DK, , 1997. Plasmodium vivax: a cause of malnutrition in young children. QJM 90: 751757. [Google Scholar]
  12. Man WD, Weber M, Palmer A, Schneider G, Wadda R, Jaffar S, Mulholland EK, Greenwood BM, , 1998. Nutritional status of children admitted to hospital with different diseases and its relationship to outcome in the Gambia, west Africa. Trop Med Int Health 3: 678686. [Google Scholar]
  13. Mockenhaupt FP, 2004. Manifestation and outcome of severe malaria in children in northern Ghana. Am J Trop Med Hyg 71: 167172. [Google Scholar]
  14. Olumese PE, Sodeinde O, Ademowo OG, Walker O, , 1997. Protein energy malnutrition and cerebral malaria in Nigerian children. J Trop Pediatr 43: 217219. [Google Scholar]
  15. Schellenberg D, 1999. African children with malaria in an area of intense Plasmodium falciparum transmission: features on admission to the hospital and risk factors for death. Am J Trop Med Hyg 61: 431438. [Google Scholar]
  16. Genton B, Al-Yaman F, Ginny M, Taraika J, Alpers MP, , 1998. Relation of anthropometry to malaria morbidity and immunity in Papua New Guinean children. Am J Clin Nutr 68: 734741. [Google Scholar]
  17. Fillol F, Cournil A, Boulanger D, Cisse B, Sokhna C, Targett G, Trape JF, Simondon F, Greenwood B, Simondon KB, , 2009. Influence of wasting and stunting at the onset of the rainy season on subsequent malaria morbidity among rural preschool children in Senegal. Am J Trop Med Hyg 80: 202208. [Google Scholar]
  18. Mitangala PN, D’Alessandro U, Donnen P, Hennart P, Porignon D, Bisimwa Balaluka G, Zozo Nyarukweba D, Cobohwa Mbiribindi N, Dramaix Wilmet M, , 2013. Malaria infection and nutritional status: results from a cohort survey of children from 6–59 months old in the Kivu province, Democratic Republic of the Congo [in French]. Rev Epidemiol Sante Publique 61: 111120. [Google Scholar]
  19. Alexandre MA, Benzecry SG, Siqueira AM, Vitor-Silva S, Melo GC, Monteiro WM, Leite HP, Lacerda MV, Alecrim M, , 2015. The association between nutritional status and malaria in children from a rural community in the Amazonian region: a longitudinal study. PLoS Negl Trop Dis 9: e0003743. [Google Scholar]
  20. Oldenburg CE, Guerin P, Berthé F, Grais R, Isanaka S, , 2018. Malaria and nutritional status among children with severe acute malnutrition in Niger: a prospective cohort study. Clin Infect Dis Available at: https://doi.org/10.1093/cid/ciy207. [Google Scholar]
  21. Stare D, Harding-Esch E, Munoz B, Bailey R, Mabey D, Holland M, Gaydos C, West S, , 2011. Design and baseline data of a randomized trial to evaluate coverage and frequency of mass treatment with azithromycin: the partnership for rapid elimination of trachoma (PRET) in Tanzania and the Gambia. Ophthalmic Epidemiol 18: 2029. [Google Scholar]
  22. Amza A, PRET Partnership , 2012. Community risk factors for ocular Chlamydia infection in Niger: pre-treatment results from a cluster-randomized trachoma trial. PLoS Negl Trop Dis 6: e1586. [Google Scholar]
  23. Amza A, 2017. A cluster-randomized trial to assess the efficacy of targeting trachoma treatment to children. Clin Infect Dis 64: 743750. [Google Scholar]
  24. Gaynor BD, 2014. Impact of mass azithromycin distribution on malaria parasitemia during the low-transmission season in Niger: a cluster-randomized trial. Am J Trop Med Hyg 90: 846851. [Google Scholar]
  25. Labrique AB, Christian P, Klemm RDW, Rashid M, Shamim AA, Massie A, Schulze K, Hackman A, West KP, , 2011. A cluster-randomized, placebo-controlled, maternal vitamin a or beta-carotene supplementation trial in Bangladesh: design and methods. Trials 12: 102. [Google Scholar]
  26. Leroy J, , 2011. Zscore06: Stata Module to Calculate Anthropometric Z-Scores Using the 2006 WHO Child Growth Standards. Chestnut Hill, MA: Statistical Software Components, Boston College Department of Economics.
  27. Sidhu AB, Sun Q, Nkrumah LJ, Dunne MW, Sacchettini JC, Fidock DA, , 2007. In vitro efficacy, resistance selection, and structural modeling studies implicate the malarial parasite apicoplast as the target of azithromycin. J Biol Chem 282: 24942504. [Google Scholar]
  28. Rosenthal PJ, , 2016. Azithromycin for malaria? Am J Trop Med Hyg 95: 24. [Google Scholar]
  29. Gough EK, 2014. The impact of antibiotics on growth in children in low and middle income countries: systematic review and meta-analysis of randomised controlled trials. BMJ 348: g2267. [Google Scholar]
  30. Keenan JD, MORDOR Study Group , 2018. Azithromycin to reduce childhood mortality in sub-Saharan Africa. N Engl J Med 378: 15831592. [Google Scholar]
  31. Sadiq ST, Glasgow KW, Drakeley CJ, Muller O, Greenwood BM, Mabey DC, Bailey RL, , 1995. Effects of azithromycin on malariometric indices in the Gambia. Lancet 346: 881882. [Google Scholar]
  32. Schachterle SE, Mtove G, Levens JP, Clemens E, Shi L, Raj A, Dumler JS, Munoz B, West S, Sullivan DJ, , 2014. Short-term malaria reduction by single-dose azithromycin during mass drug administration for trachoma, Tanzania. Emerg Infect Dis 20: 941949. [Google Scholar]
  33. Amza A, 2014. Does mass azithromycin distribution impact child growth and nutrition in Niger? A cluster-randomized trial. PLoS Negl Trop Dis 8: e3128. [Google Scholar]
  34. Burr SE, Hart J, Edwards T, Harding-Esch EM, Holland MJ, Mabey DC, Sillah A, Bailey RL, , 2014. Anthropometric indices of Gambian children after one or three annual rounds of mass drug administration with azithromycin for trachoma control. BMC Public Health 14: 1176. [Google Scholar]
  35. O’Brien KS, 2018. Childhood mortality after mass distribution of azithromycin: a secondary analysis of the PRET cluster-randomized trial in Niger. Pediatr Infect Dis J Available at: https://doi:10.1097/INF.0000000000001992. [Google Scholar]
  36. Golding N, 2017. Mapping under-5 and neonatal mortality in Africa, 2000–15: a baseline analysis for the sustainable development goals. Lancet 390: 21712182. [Google Scholar]
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  • Received : 12 Mar 2018
  • Accepted : 06 Jun 2018
  • Published online : 16 Jul 2018

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